Medicines

Cancer patients missing out on fertility discussions


Just over half (53%) of patients of reproductive age presenting for adjuvant chemotherapy for breast or colorectal cancer have had documented discussions about fertility preservation.

The findings, from a retrospective study of 18-45 years olds with stage l-lll cancer in South Western Sydney Local Health District, suggest a lack of consistency with clinical guidelines.

Medical oncology trainee Dr Sarah Khan told the MOGA ASM here in Melbourne that ASCO guidelines recommend fertility is discussed with all patients of reproductive age when infertility is a potential risk of treatment.

Of the patients who did not have a documented discussion about fertility, 42% were under age 40 years and 12% did not have any children.

The study found medical oncologists were by far the most likely clinicians to initiate discussions about fertility preservation, however Dr Khan said there was a need to improve awareness in other clinical groups as well.

“Usually if a patient has local disease, the surgeon will see them first, do the operation and then send them off for oncology. This can involve a delay of weeks,” she said.

“If a surgeon can address this, then patients would probably have 6-8 weeks in which they can see the reproductive specialists.  Women who need ovarian stimulation could have up to two cycles if they are seen earlier.”

Fertility preservation techniques adopted were mostly oocyte preservation and sperm banking, followed by LHRH agonist during chemotherapy, embryo preservation and oocyte transposition.

Importantly, the study found that fertility preservation did not involve a substantial delay in receiving chemotherapy (median 15 versus 20 days).

Reasons documented for not requiring fertility preservation included family completion, permanent contraception, known infertility and pregnancy at diagnosis.

Dr Khan said fertility discussions should be incorporated into multidisciplinary team meetings and involve care coordinators. Patient education could also be enhanced with the early provision of resources.

“We need to increase discussions but also make sure it is documented as well.”

She said developing electronic check boxes in the patient’s social history was a possible strategy.

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